I really appreciate this article, that tackles the shame we often feel, caused by child abuse, sexual abuse etc. Often people don’t realise it is shame. I know I have dealt with a lifetime of shame and I still am.
Which is why I now advocate against victim blaming/shaming and blame shifting etc. We have already suffered enough.
How can it be that a seemingly depressed person, one who shows clinical symptoms, doesn’t respond to antidepressants or psychotherapy? Perhaps because the root of his anguish is something else.
Several years ago a patient named Brian was referred to me. He had suffered for years from an intractable depression for which he had been hospitalized. He had been through cognitive behavioral therapy, psychoanalytic psychotherapy, supportive therapy and dialectical behavioral therapy. He had tried several medication “cocktails,” each with a litany of side effects that made them virtually intolerable. They had been ineffective anyway. The next step was electroshock therapy, which Brian did not want.
When he first came to see me, Brian was practically in a comatose state. He could barely bring himself to speak, and his voice, when I managed to get anything out of him, was meek. His body was rigid, his facial expression blank. He couldn’t look me in the eye. Yes, he seemed extremely depressed. But knowing he had been treated for depression for years without good results, I wondered about the diagnosis.
Even though we were together in my office, I was struck by a strong sense that Brian was elsewhere. I asked him what percentage of him was with me in the room.
“Maybe 25 percent,” he said.
“Where is the rest of you?” I asked.
“I don’t know,” he said, “but someplace where it is dark and I am alone.”
“Would you like me to help you get you a little more relaxed?” I asked.
He looked a bit surprised but said yes, so I grabbed a small cushion off my sofa and tossed it to him. He caught it and smiled.
“Toss it back,” I playfully commanded. And he did. His body loosened perceptibly and we talked some more. When I asked, after several minutes of tossing the cushion back and forth, what percentage of him was now with me, he responded with another smile. “I am all here now,” he said.
That’s how it went for several months: We played catch while we talked. Playing catch got him moving, relaxed him, established a connection between us — and was fun.
During our initial sessions I developed a sense of what it was like to grow up in Brian’s home. Based on what he told me, I decided to treat him as a survivor of childhood neglect — a form of trauma. Even when two parents live under the same roof and provide the basics of care like food, shelter and physical safety, as Brian’s parents had, the child can be neglected if the parents do not bond emotionally with him.
I am always shocked by apologies, especially when they seem genuine. Having not received many apologies in my life, and always being able to detect the non genuine, non remorseful apologies, it comes as a surprise to me, when more genuine apologies are offered.
It actually helps, when I do receive genuine apologies, because it raises my belief in humanity.
The psychologist, who disagreed with my view about mental health policy ‘shaming’ those most impacted, most suffering, most vulnerable, has emailed me and apologised and is considering my view further, and I am grateful for that.
He is a very educated man and has worked with the APA etc and is very ‘high up’ in the mental health world in the US.
I will ponder some more about this apology and my response. My capacity to not immediately respond, react, and to sit back and think, digest, consider, ponder, is such proof of my continued healing. Continue reading